ObjectiveParamedics Providing Palliative Care at Home was launched in two provinces, including a new clinical practice guideline, database, and paramedic training. The aim of this study was to evaluate patient/family satisfaction and paramedic comfort and confidence.MethodsIn Part A, we gathered perspectives of patients/families via surveys mailed at enrolment and telephone interviews after an encounter. Responses were reported descriptively and by thematic analysis. In Part B, we surveyed paramedics online pre- and 18 months post-launch. Comfort and confidence were scored on a 4-point Likert scale, and attitudes on a 7-point Likert scale, reported as the median (interquartile range [IQR]); analysis with Wilcoxon ranked sum/thematic analysis of free text.ResultsIn Part A, 67/255 (30%) enrolment surveys were returned. Three themes emerged: fulfilling wishes, peace of mind, and feeling prepared for emergencies. In 18 post-encounter interviews, four themes emerged: 24/7 availability, paramedic professionalism and compassion, symptom relief, and a plea for program continuation. Thematic saturation was reached with little divergence. In Part B, 235/1255 (18.9%) pre- and 267 (21.3%) post-surveys were completed. Comfort with providing palliative care without transport improved post launch (p = < 0.001) as did confidence in palliative care without transport (p = < 0.001). Respondents strongly agreed that all paramedics should be able to provide basic palliative care.ConclusionsAfter implementation of the multifaceted Paramedics Providing Palliative Care at Home Program, paramedics describe palliative care as important and rewarding. The program resulted in high patient/family satisfaction; simply registering provides peace of mind. After an encounter, families particularly noted the compassion and professionalism of the paramedics.

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Geographic patterns of genetic and morphological divergence amongst populations of a river crab ( Decapoda, Potamonautidae) with the description of a new species from mountain streams in the Western Cape, South Africa. 30,[181][182][183][184][185][186][187][188][189][190][191][192][193][194][195][196][197] Recent systematic research has revealed that Potamonautes brincki comprises two genetically and morphologically distinct population groups. The systematic affinities between these population groups have remained uncertain. In the present study, the relationship between the population groups was examined. Eleven populations were collected from high mountain streams in the Western Cape, South Africa and used in the genetic and morphological analyses. Allozyme electrophoresis of 13 protein coding loci separated two main population groups: group A (Cape Peninsular groups) and group B ( Hottentot's Holland ) at I = 0.73. Two additional genetic groups were evident, with group B being conspecific to group A, and group D being conspecific to group C. Morphological examination of pleopod 1 and the terminal segment of the mandibular palp showed considerable differences between the two main population groups, with groups A and B being similar and groups C and D being similar. The morphometric data for the four main groups were examined using discriminant functions analysis and the two main groups were compared using analyses of covariance. Discriminant functions analysis showed a moderate degree of overlap between the groups. Additional morphometric data showed a clear discrimination between the two main population groups. The genetic and morphometric data sets exhibited congruent patterns of variation and the data showed the presence of a species boundary. A new freshwater crab species, P. parvicorpus sp. n., is described. The results of the present study are discussed in the light of historical and contemporary factors that are likely to have contributed to speciation.